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Acta Ortopédica Mexicana

ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología
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2025, Number 5

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Acta Ortop Mex 2025; 39 (5)

Combined spinopelvic fixation with long instrumentation in a patient with multifragmentary sacral injury and multiple lumbar vertebral fractures: Case report and literature review

Altamirano-Cruz M, Baltazar-Rodríguez G
Full text How to cite this article 10.35366/121079

DOI

DOI: 10.35366/121079
URL: https://dx.doi.org/10.35366/121079

Language: Spanish
References: 13
Page: 305-312
PDF size: 534.20 Kb.


Key words:

multiple trauma, spinopelvic dissociation, pelvic fracture, spinal fracture, long spinal instrumentation.

ABSTRACT

Polytrauma refers to significant injuries to three or more points in two or more different AIS anatomical regions along with physiological variables. Polytrauma presents a clinical and therapeutic challenge on its own; however, the combined fracture of the spine and pelvis entails its own set of challenges. In a combined spine and pelvis fracture, we may encounter a spino-pelvic dissociation, which is anatomically characterized by the inability to transmit loads through the spine to the pelvis and consequently to the lower limbs. This interferes with the transmission of axial loads and stability. In this scenario, it has been demonstrated that conventional plates and screws are not sufficient. Faced with this problem, it has been observed that a long posterior fixation can be a good alternative, as it has been shown to provide greater stability and earlier rehabilitation.


REFERENCES

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  2. Whitney E, Alastra AJ. Vertebral fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

  3. Davis DD, Tiwari V, Kane SM, et al. Pelvic fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

  4. Navas L, Mengis N, Zimmerer A, Rippke JN, Schmidt S, Brunner A, et al. Patients with combined pelvic and spinal injuries have worse clinical and operative outcomes than patients with isolated pelvic injuries analysis of the German pelvic registry. BMC Musculoskelet Disord. 2022; 23(1): 251.

  5. Hirschfeld M, Pascual-López FJ, Guerado E. Spinopelvic dissociation: current concepts. Rev Esp Cir Ortop Traumatol. 2024; 68(4): 398-408.

  6. Patel S, Ghosh A, Jindal K, Kumar V, Aggarwal S, Kumar P. Spinopelvic fixation for vertically unstable AO type C pelvic fractures and sacral fractures with spinopelvic dissociation- A systematic review and pooled analysis involving 479 patients. J Orthop. 2022; 29: 75-85.

  7. Joseph JR, Okonkwo DO. Evaluation and classification of spinal instability. In: Winn HR, ed. Youmans and Winn neurological surgery. 8th ed. Philadelphia (PA): Elsevier Inc; 2023.

  8. Wang W, Pei B, Wu S, Lu D, He P, Ma C, et al. Biomechanical responses of human lumbar spine and pelvis according to the Roussouly classification. PLoS One. 2022; 17(7): e0266954.

  9. Sobhan MR, Abrisham SM, Vakili M, Shirdel S. Spinopelvic fixation of sacroiliac joint fractures and fracture-dislocations: a clinical 8 years follow-up study. Arch Bone Jt Surg. 2016; 4(4): 381-6.

  10. Cearra I, Alonso R, Martinez-Ogalla D, Hoyos J, Lauzirika A, Mongil R, et al. Sacral fracture with spino-pelvic dissociation: a literature review. Rev Esp Cir Ortop Traumatol. 2013; 57(6): 434-42.

  11. Nguyen JH, Buell TJ, Wang TR, Mullin JP, Mazur MD, Garces J, et al. Low rates of complications after spinopelvic fixation with iliac screws in 260 adult patients with a minimum 2-year follow-up. J Neurosurg Spine. 2019; 30(5): 635-43.

  12. Berk T, Zderic I, Schwarzenberg P, Drenchev L, Skulev HK, Pfeifer R, et al. Antegrade posterior column acetabulum fracture screw fixation via posterior approach: a biomechanical comparative study. Medicina (Kaunas). 2023; 59(7): 1214.

  13. Yang H, Li Z, Hai Y, Pan A, Guan L, Liu Y. Comparison of complications, revisions, spinopelvic parameters, and health-related quality of life after posterior spinal fusion using multiple-rod constructs or two-rod constructs for adult spinal deformity: a systematic review and meta-analysis. Eur Spine J. 2023; 32(10): 3634-50.




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Acta Ortop Mex. 2025 Sep-Oct;39